Provider Demographics
NPI:1265601033
Name:MIDDLESEX INTERNAL MEDICINE ASSOCIATES, INC.
Entity type:Organization
Organization Name:MIDDLESEX INTERNAL MEDICINE ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:SUMNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-485-7660
Mailing Address - Street 1:28 LORD RD
Mailing Address - Street 2:SUITE 255
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-4548
Mailing Address - Country:US
Mailing Address - Phone:508-485-7660
Mailing Address - Fax:508-481-4540
Practice Address - Street 1:28 LORD RD
Practice Address - Street 2:SUITE 255
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-4548
Practice Address - Country:US
Practice Address - Phone:508-485-7660
Practice Address - Fax:508-481-4540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA32745207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM15558OtherBLUE CROSS BLUE SHIELD
MA9768246Medicaid
MA600427OtherTUFTS HEALTHPLAN
MAM15558OtherBLUE CROSS BLUE SHIELD
MAM15558Medicare PIN